Psychological Aspects of Child Sexual Abuse 

Psychological Aspects of Child Sexual Abuse

Instructions/Descriptions

Psychological Aspects of Child Sexual Abuse

ABSTRACT.

According to statistics, about 90% of people were emotionally abused in childhood, but many do not realize, deny or, worse, abuse their own children or others, considering that their treatment of childhood was “natural and normal.” Emotional abuse is a form of aggression, but the law can not penalize it.

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Most parents believe that child abuse means physical or sexual violence and / or child neglect. But they do not know that they can hurt the child simply by their excessive attitude. The emotional abuse is any behavior that is intended to control, subjugate, submit other beings through fear, intimidation, humiliation, blaming, and “growing” guilt, coercion, manipulation, invalidation etc.

The consequences of emotional abuse are multiple, varied, extremely serious; they leave marks for life, affecting child development at various levels – emotionally, intellectually and even physically. Moreover, it will affect the future adult’s social and professional life, relationships and physical and mental health, to a greater or lesser extent, depending on the type of the emotional abuse, and on its frequency and intensity. Keywords: behavior, emotional abuse, violence, control, sexual abuse

1. Introduction Abuse means the use of force in order to try to dominate a child, to compel him/her to do dangerous things that he/she does not want to do, expose him/her to hazardous situations or to situations perceived by him/her as dangerous. Any action that causes injury or psycho-emotional disorders is an abuse.

The abuse can be of several types:

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Physical abuse – involves the use of physical force against children and subjecting them to hard work that exceed their capabilities, actions that result in damage of their body integrity.

Emotional abuse – is the inappropriate behavior of adults towards children, behavior that adversely affects a child’s personality in development. Child rejection, forced isolation, terrorization, ignoration, humiliation and corruption are manifestations of child abuse.

Sexual abuse – consists in exposing the child to watching pornography, seduction (advances, caresses and promises) or involvement in sexual acts of any kind.

Economic abuse – implies attracting, persuading or forcing the child to do income generating activities, the adults close to the child at least partially or indirectly benefiting from this revenue. The economic abuse leads to removing the child from school, thus depriving him of the chance to access superior social and cultural levels.

Neglection – is the adult’s inability or refusal to appropriately communicate with the child, and the limited access to education.

The term “sexual abuse” refers to the sexual exploitation of a child whose age does not allow him/her to understand the nature of the contact and to adequately resist it. This sexual exploitation may be done by a child’s friend whom he/she is psychologically dependent on.

The sexual abuse can have different aspects: – sexual evocation (phones, exhibitionism, pornography, the sexual

content of the adult’s language etc.) – sexual stimulation (erotic contact, masturbation, incomplete genital

contact, forced participation in the sexuality of a couple etc.) – making sex (rape or attempted rape).

1.2 Issues of Abuse

1. a) Children may be abused since very young. Children may be abused from a very early age. They are often seduced

by games in a sexual- abusive situation. The abuser often establishes positive relationships with both parents and the child.

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The child is encouraged or forced to engage in the abusive relationship. This is achieved through rewards and / or threats. The sexual activity is presented as something special, and the child should be considered lucky because he/she has “a chance” to participate in it. The child is unable to understand what is happening. Just when he/she is told that “the game is secret” he/she begins to understand that something is wrong.

The child’s role in this game varies. He/she may be required to actively participate in the game or be passive, as if “he/she would sleep”.

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1. b) The agressors are rarely violent Sexual abuse within the family or within the family network is rarely

violent. Pattersen (1990) emphasizes that pedophile people are seldom violent; on the contrary, they appear to be sensual and protective. However, the abuse is emotionally traumatic, because the child’s silence is often ensured by corruption, and, at the same time, the child is made to feel guilty and responsible for what happens.

The abuse may also be violent or become violent if the game evolves in intromission. The abuser often develops a behavioral model of restraint. The abuse may continue until the child is able to escape from that relationship or until someone realizes what is happening and puts an end to the situation.

A confused and fearful aspect of sexual abuse is represented by the secret that the child must keep and by the feeling of complicity that dominates him/her. c) The abuse associated with other types of maltreatment.

The sexual abuse is often associated with other types of abuse described above. A child who has been sexually abused within his/her own family might also have been exposed to other types of maltreatment. All these have, of course, a number of common features.

However, the action for sexual abuse is different from the activity of other types of maltreatment, because, in this case, we do not deal only with serious criminal behavior, but also with a taboo behavior. This case will be treated both from the point of view of the child’s welfare and as a court case. d) Child sex tourism

At the seminar “Abuse and violence against children”, held in Brasov, in March 2000, which was attended by prosecutors, policemen, representatives of the civil society and of specialized institutions in Romania and Italy, it has been shown that the violence against minors is a global phenomenon.

The Italian experts and the representatives of the civil society have acknowledged that Italy is the leading country which exports sex tourists to Romania. Sex tourism refers to those individuals, especially pedophiles, who came from Italy to Romania just to have sex. There are some travel agencies that, for a certain price, can provide these individuals pictures of the children available. They do not necessarily want to come to Romania; they can also go to Latin America, Thailand and Taiwan.

Because social and legal penalties for sexual abuse are severe and because there are no signs of sexual abuse that can be easily noticed by others, just as with physical abuse, many abused people refuse reporting such cases. The uncovered abuses are more numerous than those reported. This is also true for child sex tourism.

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1. e) The incest – a special form of abuse Most authors agree regarding the existence of traits that can be

frequently and regularly seen in the “incestuous” family: – The same drama is repeated over several generations. – There is a significant family dysfunction. – The child is not recognized as a subject. The incest often begins within an atmosphere of seduction quickly

accompanied by constraints and threats. The father: if the father’s personality often reveals some psycho-

pathological traits (perversity, psychopathy, mental deficiency, alcoholism), most often these traits are not evident. Numerous surveys have shown the existence of emotional immaturity, of a past marked by emotional deficiencies and separation. Prohibitions are wrongly internalized.

The emotional relationships are experienced as an extreme dependence. The guilt related to the incestuous act is rarely felt, the father even asserting his right of possession or initiation duty.

Some authors have described two types of incestuous fathers: – One who is experiencing his perversion in a depressed manner: child

among children, he pities himself, he cries in jail, he transforms his daughter into the mother he wanted to have (passive-dependent).

– One who justifies his sexual possession attitude towards children by theoretical arguments. He often has a dictatorial behavior (active- dependent).

The mother: her past is often “haunted” by sexual abuse or violence. Depressive traits are common. Paradoxical attitudes are not rare: she delegates childcare to the father; she lets children sleep with their father and, under various pretexts, she sleeps in another room. Usually, the mother’s unconscious complicity is present: she “does not want to know anything” and she passively (or a perversely?) accommodates herself to the situation.

The couple and the family: many families are characterized by social isolation, by the scarcity of social relations. The mother’s absence due to work during the night, illness or divorce can promote the transition to an incestuous act which, until then, remained in a latent state.

There are frequent misunderstandings and difficulties in the couple’s sexuality. Some authors have noted that, sometimes, sexual abuse seems to have the function to avoid the sexual conflict in the parental couple and, some other times, it limits the conjugal conflict and prevents family breakup.

For other authors, the couple’s relationship is based on the “violent husband – female subject” dependency. Witin this couple, the main links seem to be dominated by complicity and by the pleasure of absolute control. The couple’s sexuality is low or even nonexistent.

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Incestuous relationships – in 30-40% of cases, we are speaking of father-daughter incestuous relationships (and, in as many cases, according to other case studies, of grandfather – granddaughter incest). Most occur when the victim is aged between 6 and 12 years. f) Conflicts in dysfunctional families

In all families there are conflicts and differences. In functional families, members learn to adjust to the differences, to live conflicts and to express their strong feelings (anger, for example) without this having negative consequences and harm the sustainability of relationships. Most people who lived in dysfunctional families, such as those where there has been sexual abuse, had the opportunity to learn such things.

Conflicts are inevitable, especially when we do not have the same opinion on several issues or when we feel threatened, ignored, rejected.

1.3 Causes of Abuse At a structural level, there can not be described a particular psycho- pathological organization of the victim. Thre has been already indicated the frequency of the depressive features, where the feelings of guilt, shame, self-devaluation dominate. Disturbances in the organization of narcissism (self-love) are common; they are marked by a very intense sense of humiliation, a lack of self-esteem which explains, in part, subsequent pathological behaviors in adolescence and adulthood. For some authors (Stoller), pathological behaviors in adulthood, especially some perverse behavior, would be an attempt to escape the feeling of humiliation suffered in childhood.

The main causes of sexual abuse are poverty, illiteracy, exploitation and vulnerability, violence, education, alcohol, drugs and mental illness. These data reflect the relationship between social problems and the problem of the increased number of sexual abuse cases.

1.4. Defense Mechanisms Incest victims continue, in adulthood, to resort to various survival techniques that they were using during childhood in order to deal with abuse. For example, it is known that many cases of personality duplication are caused by a serious physical or sexual abuse.

By dissociating his/her personality, a child can endure the terror of being raped, persecuted. Personality disintegration is probably one of the most radical defense mechanisms used by the incest victims. As it is known, such behavior is likely to be highly disruptive in adulthood. There are other numerous defense mechanisms against abuse that, without being radical, can,

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however, create difficulties to their adult survivors. We speak here of refusing to sleep in darkness, addiction, etc. For some time, the defense mechanism played a useful role but now, in adulthood, it may prevent the survivor to take his/her life into his/her own hands.

2. Clinical and Behavioral Manifestations Physical attacks can be seen especially in the first 24-48 hours following the sexual abuse: bruises, swelling, bleeding, even severe genital lesions, genitourinary infections and sexually transmitted diseases. If physical examination is required (forensic finding or care), it must be done in an appropriate psychological context, with the previous preparation of the child.

In any case, this should not represent a further intrusion, a kind of medical “rape”, worsening the already suffered trauma. On a forensic plan, it is important to sample the elements that may help identify the agressor.

Psychological symptoms are frequent and show the suffered mental trauma. They are different depending on the uniqueness of the event or on its repetition.

There can be direct signs of distress: different somatic complaints, fatigue; food disorder, with a sudden onset of: anorexia, vomiting, refusal to feed; common sleep disorders: fear of sleep, bedtime rituals, nightmares, repeated nighttime awakenings or night terror; affective disorders: apathy, feeling confused, disinterest for games, sad face, bouts of tears, depression; adjustment disorders: sudden school difficulties, isolation, escape, refusal to stay at home or elsewhere with an adult. There are also situations when the school is seen as a means to escape the traumatic family situation.

Other behaviors can be considered as indirect witnesses of the traumatic sexual experiences experienced by the child (especially when it is repeated): unexpected and prolonged masturbation, inappropriate sexual conduct with an open curiosity, language that uses adult sex words; sexual games with dolls or children. All these behaviors do not necessarily testify a sexual abuse but their sudden appearance without a particular event to explain them, an evocative family situation, can guide the clinician towards this possibility.

The situations that can detect sexual abuse are varied. Children can often be very “direct” in expressing their memories related to certain intimate problems. Also, some younger children may confess their sexual experiences while playing, by sketching them verbally and / or by means of gestures (MacFarlane, 1986).

A boy, for example, might require the kindergarten teacher to play with him in the same way “his daddy” does and if the child were asked to show how his daddy played with him, he should be able to demonstrate. But, generally, adults do not believe what the child

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says or they feel better if they talked about something else. A child who is not believed might try the next time not to directly confess his problems, making, however, further attempts to do it indirectly (Lindblad, 1989).

Older children sometimes talk to other children of the same age who, in turn, might tell it to adults. However, usually, the child keeps the secret of those stories, and denies them if asked directly.

The child who is aware of the “danger” and of the fact that he/she must not talk about it, and who has been probably threatened or “double- crossed”, may protest against the event of a visit to his father living elsewhere, during the weekend, doing so without giving any explanation.

However, he/she might say: “Dad likes to play silly games – I do not want to visit him”. Then, the child stops breathing for several seconds while the adult decides whether he/she really needs to ask questions about the child’s statement or whether “it is better to leave things as they are because, anyway, the child said some weird things.”

The secrecy that reigns over the abusive relationship and the child’s vulnerability force him/her to be silent and allow the recurrence of the abuse for many years. The abuse takes place only when the child is alone with the abuser and the event can not be shared with anyone else. The “secret” is ensured by threats and corruption.

“If you tell anyone what happened, I’ll go to jail”, “If you’ll tell your mother, she will always hate you”. As time passes, the child feels increasingly guilty and he/she will use more and more energy to cover the facts to which he/she was drawn. 2.1 Consequences The children who were exposed to the sexual abuse from a small age will have an early sexualized behavior.

They will approach other people in a way similar to the one learned from the abuser. They may have a form of pseudo-mature flirtation behavior. Kari Killén quotes the words of a pediatrician whom he consulted in connection to a child who presented such deviant behavior: “it is hard to judge someone’s feelings in such a situation.

She acts like a bitch. I reacted in the same way in which I respond to a bad woman.” The girl was four years old.

These children are often reluctant to have contact with other children of their age. They are afraid that someone “could see.” They isolate themselves and perceive themselves as different from other children. This difference can be seen in the sense of “worse,” “blackguard” or “more adult,” secretly.

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Their ability to concentrate weakens and their school results deteriorate rapidly. They often try to avoid gym classes and undressing in the presence of other children and going to shower, “as others might notice it”. For the same reasons, they will try to avoid the school doctor. At the

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same time, they will struggle to avoid routine medical checks; they will often contact the nurse for various stomach pains, headaches, leg pain and other somatic problems.

Serious sleep disorders, phobias and nightmares with sexual content may also be signs that a child has been sexually abused. Hysterical seizures accompanied by screaming, tremors or fainting may also occur. It is also encountered a form of pseudoepilepsy (Putnam, 1985; Finkelhor, 1986; Conte, Berliner, 1988) and appetite disorders (Oppenheimer et al. 1985; Sloan, Leichner, 1986).

During adolescence, the frequency of suicidal thoughts, threats and attempts will increase. Unable to escape the abuse, they will act as abuse disclosure consequences could be worse than exposing the abuse. Thus, suicide can be seen as the only way out from an irresolvable dilemma: to tell or not to tell.

There are described different types of self-destructive behavior (Shapiro, 1987). Drug abuse since the early teens can somehow ease their pain. Prostitution might be another destructive, but logical way to escape, from a certain point of view (they learned it at home). These children are not able to focus on learning something at school and they will not be adequately prepared to compete on the labor market.

It can be said that it is more difficult to obtain a proof related to sexual abuse than to physical abuse. Exceptions are cases of sexually transmitted diseases and pregnancy cases. Sometimes, certain physical changes can be demonstrated, such as the dilatation of the anus, some traces around other body openings, pelvis, thighs and breasts.

There are other somatic symptoms that may be inconclusively related to sexual abuse; for example chronic urinary tract and vaginal infections. Bleeding and itching of the genital and anal areas, chronic constipation, irregular and delayed menstruation can also be correlated with sexual abuse. Psychosomatic disorders, such as stomach pain and pelvic pain may also occur. Other children may have difficulty even to walk or sit.

Some children may be particularly concerned about sexual games and show detailed knowledge about adult sexuality. They are very active and take the initiative in sexual games with other children at kindergarten, for instance. Many of them regress and come to behave in ways characteristic of an earlier stage of development: for example, urinary incontinence, baby language.

This identification dilemma appears in sexual abuse because regression is frequently met in children undergoing various types of stress, including family crises or nursery influence. When a child shows several of these symptoms at the same time, the adult should take them into consideration, as sexual abuse might be a

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possible explanation. This hypothesis should be included in making the differential diagnosis.

Sexuality rules change very quickly. Pornographic films and literature for / with children are easily available. Other cultural changes also occur, including the increase in the number of divorces that result in an increased number of stepfather families, where incest taboos are supposed to be lower compared to families with biological parents.

Although there are some studies showing that child sexual abuse does not leave marks on his/her personality over time, however, most of them also stress that it undoubtedly affects the normal evolution of the victim, namely:

• the abused children suffer from anxiety and depression more frequently than other children;
• they show a very low level of self-esteem regarding sexual behavior (i.e., they are dissatisfied after sex or they are often in embarrassing sexual situations);
• for male victims abused by men, the probability to become homosexuals increases 4 times.

The consequences of child sexual abuse can be classified into: a) physical (venereal disease, serious injury), psychological (from

phobias and nightmares to suicidal tendencies) and social (difficult interpersonal relationships, delinquency, prostitution);

1. b) short-term and long-term (considered “delayed psychological bombs”, including chronic depression, self-destructive tendencies, function- ing difficulties in marital-parental roles).

In women, four core symptoms of childhood sexual psychotrauma occur:

1) oppressive, obsessive memories, often accompanied by nightmares related to the abuse, which causes them fear before bedtime;

2) very pronounced self-underestimation; 3) distrust of men, and sometimes of women; 4) sexual indifference, vaginismus and frigidity. Such women can not defend themselves, give in easily, and become

victims of insistent demands. Showing multiple symptoms (depression, anxiety, alcohol and drug abuse, difficult interpersonal relationships), they can get the attention of psychiatrists. From the perspective of some specialists, eating disorders, such as anorexia and bulimia, are often linked to childhood sexual trauma.

Obsessions (obsessive thoughts, clear visions or outbursts of memories, nightmares), repressions (denial and emotional numbness), combined with guilt, fear and anger, are key features of PTSD. Posttraumatic stress

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disorder traits can also be found in cases of rape, which may lead to feelings of humiliation, increased vulnerability and the fragility of personal identity.

The goal of the treatment of women with symptoms of childhood sexual trauma consists in finding the abuse and in the victim’s subsequent ability to share both her past and present experiences, in connection with the incident, including the hatred felt for the rapist and the grief caused by the fact that once her mother was unable to protect her from evil. The victim must transfer the responsibility for what happened on the adult who committed the abuse, thus freeing herself.

3. The Sexual Abuse in Romania – Statistics and Causes The number of sexual offenses against children has doubled during 1998- 2000; 90% of street children prostitute, and, in most orphanages, they were mistreated in one way or another.

According to a study made by the government agency for child protection together with “Save the Children” and UNICEF Romania organizations, the number of child abuse cases has increased in recent years, such situations being encountered both in the family and in the institutions for the protection of minors.

The study refers to all forms of child abuse (emotional, physical or sexual) and to the methods of their exploitation (prostitution, sex tourism and others). The number of the sexual offenses against children has doubled during 1998-2000, compared to previous years; a quarter of the victims were children aged under 14 years.

Also, in what concerns children and their families, nearly 90% were at least once subjected to emotional abuse, while three quarters suffered from physical abuse. The same study reveals that the majority of street children prostitute in order to survive, but over 90% of them refuse to talk about the abuses to which they are subjected.

Around 10% of the girls living on the street prostitute from a very young age, i.e. nine or ten years old. Pedophilia is increasingly common among street children, with a trend of development and organization. Many of them – especially boys – are the victims of their friends on the street or of the persons who recruit them in order to put them in connection with some clients.

The authors of the study argue that, in Bucharest, there are around 40-50 adult clients, mostly foreigners who came to Romania under the pretext of business or tourism. They own several apartments in the capital, where they bring the children (most aged between 8 and 15 years), and they film or photograph them while having sex with them.

The study also revealed the existence, in care institutions, of all forms of abuse against children, either by older colleagues or by the staff within

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the centers. Thus, nearly half of the 3,000 respondents (institutionalized children) confirmed the practice of beating penalties, but admitted that it has been less applied in the past two or three years. More than a third of the juveniles from care centers said they know about other children forced to participate in sexual practices, but few admitted that they were subjected to such abuse or that it happened in their institution.

In Romania, the explanations of the context in which abuse and neglect occur are:

1. The punitive education mentality, lack of empathy for the child, for his/her needs and aspirations. “You have to be strict with child,” “The child should be accustomed to the hardships of life,” “Beating comes from Heaven,” “Children must obey” are just some of the Romanian educational patterns.
2. The existence of taboos, false modesty and sense of helplessness that explain community indifference and non-intervention in cases of abuse.
3. The lack of an effective child protection – medical, educational, social and legal services have limited and reduced resources. These deficiencies are accompanied by the inadequate mentality of those working in this field.
4. The lack of the necessary legislation. The issue of child abuse is weakly, vaguely and incompletely mentioned in the national legislation. There has not been developed a domestic legal system that strengthens and supports the enforcement of the international law in the field, to which Romania adhered. For example, the emotional abuse is not provided in the Romanian legislation.
5. Conclusion In Romania, child abuse/neglect is common. Abuse and neglect are seen as something quite normal in many families and in child care institutions.

According to a national study conducted by the National Authority for Child Protection and Adoption, on a sample of 1555 households that included at least a minor in the family and 1259 children between 13-14 years, 9.1% of the children surveyed said that they underwent a type of sexual abuse.

Most children, i.e. 5,7%, said that their own drunk parents forced them to do different indecent actions, and 2.2% said that they were forced to caress their erogenous body parts. The majority of the abused children is from Moldova, Oltenia and Crisana Maramures and is part of large and poor families, with a fairly low level of education.

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REFERENCES Margolin, L. (1992), “Sexual Abuse by Grandparents,” Child Abuse & Neglect

16(5): 735-742. Margolin, L. (1994), “Child Sexual Abuse by Uncles: A Risk Assessment,”

Child Abuse & Neglect 18(3): 215-225. Margolin, L. (1992), “Child Abuse by Mother’s Boyfriend. Why the

overrepresentation?” Child Abuse & Neglect 16(4): 541-552. Margolin, L., Craft, J.L. (1990), “Child Abuse by Adolescent Caregivers,”

Child Abuse & Neglect 14(3): 365-374. MacFarlane, K. (1986), Sexual Abuse of Young Children. London: Holt,

Rinehart & Winston. Putnam, F.W. (1985), “Dissociation as a response to extreme trauma” in

Childhood antecedents of multiple personality. R.P. Kluft (ed.). Washington D.C.: American Psychiatric Press, 65-97.

Putnam, F.W. (1993). “Dissociative disorders in children: Behavioural profiles and problems”. Child Abuse & Neglect 17(1): 39-45.

Oppenheimer, R., Hawells, K., Palmer, R.L., Chaloner, D.A. (1985), “Adverse sexual experiment in childhood and clinical eating disorders: A preliminary description,” J. Psychiat. Res. 19(2/3): 357-361.

Sloan, G.H., Leichner, P. (1986). “Is there a relationship between sexual abuse or incest and eating disorder?” Canadian Journal of Psychiatry 31: 656-660.

Shapiro, S. (1987). “Self-mutilation and self-blame in incest victims”. American Journal of Psychotherapy 41(1): 45-54.

Calam, R., Slade, P. (1987). “Eating disorders and sexual experience?” (Paper given to the Conference of the British Psychological Society, London).

Sloan, G., Leichner, P. (1986). “Is there a relationship between sexual abuse or incest and eating disorders?” Canadian Journal of Psychiatry 31: 113-118.

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Psychological Aspects of Child Sexual Abuse

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